N.J. Admin. Code § 10:73-3.5

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:73-3.5 - Eligibility and referral for CMO services

(a) A child, youth, or young adult may be eligible for CMO services if:

1. He or she meets the requirements of this subchapter and is:

i. Enrolled in Medicaid/NJ FamilyCare as described at N.J.A.C. 10:49-2, and not enrolled in: :

(1) The Medically Needy Program, except that pregnant women in that program may be eligible;

(2) The Home and Community Based Services Waiver Program;

(3) The DDD Waiver Program;

(4) The Traumatic Brain Injury Waiver Program;

(5) The Community Resources for People with Disabilities Waiver Program; or

(6) The Home Care Expansion Program; or

ii. Receiving services from the Children's System of Care and is not eligible for Medicaid/NJ FamilyCare; and

2. He or she has been determined by the Department of Children and Families, or its designated contract system administrator (CSA), to require CMO services due to any one or any combination of the following:

i. Serious emotional or behavioral health challenges resulting in significant functional impairment which adversely affects his or her capacity to function in the community;

ii. His or her CSOC assessment indicates a need for the intensive level of case management services provided by a CMO;

iii. He or she is involved with one or more agencies or systems, including, but not limited to:

(1) DMHAS;

(2) CP & P;

(3) Crisis/emergency service providers;

(4) Department of Human Services or Department of Children and Families provider agencies;

(5) JJC; or

(6) The court system;

iv. A risk of disruption of a current therapeutic placement exists;

v. A risk of a psychiatric rehospitalization exists; or

vi. A risk of placement outside the home or community exists, except for:

(1) Foster care placement, unless one or more of the conditions in (a)2i through v above are also present.

(b) Referrals to CMOs for CMO services shall be made only by the Department of Children and Families' Children's System of Care Implementation Team or other agent designated by the Department, including, but not limited to, the CSA.

(c) A child, youth, or young adult shall not be referred for CMO services if:

1. His or her immediate crisis is not stabilized;

2. His or her sole diagnosis is:

i. Substance abuse; or

ii. Developmental disability;

3. His or her CSOC assessment, or an evaluation performed by an authorized agent of the Department of Children and Families, does not indicate a need for CMO services; or

4. The child, youth or young adult, or his or her parent or caregiver, refuses CMO services.

(d) All records supporting determinations of eligibility or ineligibility made in accordance with this subchapter shall be maintained by the CMO provider.

N.J. Admin. Code § 10:73-3.5

Repeal and New Rule, R.2006 d.421, effective 5/21/2007.
See: 38 N.J.R. 2585(a), 39 N.J.R. 2096(a).
Section was "Access to services".

Amended by 53 N.J.R. 1492(a), effective 9/7/2021